More and more we are hearing about person-centred care, but, what is it?
So, ‘person-centred care is a way of thinking and doing things that sees the people using health and social services as equal partners in planning, developing and monitoring care to make sure it meets their needs.’
But, as a means of expediency systems are created and we are all expected to fit in with these systems, but fitting in for the sake of the system and expediency is not person-centred care for it is following the old way of institutional care.
One Definition institutional care
‘Institutional care’ is a type of residential care for large groups of children. It is characterised by a one-size-fits-all approach according to which the same service is provided to all children irrespective of their age, gender, abilities, needs and reasons for separation from parents.
But, it is not just for children as it can and is for everyone, so another definition is
Institutional care Definition – Law Insider, which states ‘Institutional care means care provided in a hospital, skilled or intermediate nursing home, or other facility certified or licensed by the state primarily affording diagnostic, preventive, therapeutic, rehabilitative, maintenance or personal care services. Such a facility provides twenty-four-hour nursing services on its premises or in facilities available to the institution on a formal prearranged basis.’
In other words, institutional care, is following the way of ‘one fits all’, but we are not objects, we are human beings and as such, we are all individuals and we should be seen as individuals wherever we are.
But, to allow everyone, all the time, to receive person-centred care, may not , while right, may not be cost effective and could considerably increase the cost of care. In the UK we have the NHS for health care, which in many instances is ‘standardised’ for the ease of running a large organisation, especially when one is in hospital, as it is ‘free at the point of delivery’. If, we are looking for more individualism and priority then we could always choose private funded care, where some forms of person-centred care could be available, but not always.
However, private care is expensive to the individual and many of us don’t have the financial means to have that choice.
But, that should not mean that some forms of person-centred care should not be available. Being more informed of the care could be one area. On admission we will be advised on some aspects, such as, meal times, but, perhaps, not when a doctor may be available to enable a conversation about the care to be given, even down to your medication, if any, will be dealt with. One of my own objections is not being consulted on any changes to my current medications and only aware of any changes when medications are given, which will follow the hospital ward routine and not how I usually administer my own medication. Much is said about a persons capacity, but when in hospital ones capacity to administer their own medication is ignored, even though no test of capacity has been conducted. Surely, any changes should be discussed with the patient and not, just changed by a doctor, who at the time, may not even have seen the patient, let alone talked with them about anything.
But, the same is also done for DNR’s (Do Not Resuscitate) which can and are placed on a patients record with no discussion and that is a ruling on life and death, when we are advised that doctors are not allowed to do euthanasia, but have done in the past and currently do. some years ago there was the ‘Liverpool Pathway‘,
However, there were methods before LCP and more than likely even now, hence the question about DNRs
So, even in dying there was a lack of person-centred care, and with all this there could certainly arise a question of trust in care.
But, in home care what is stopping person-centred care, well for one finance another an insufficiency of carers and maybe a lack of quality training, understanding and commitment in some instances.
The lack of funding is by far a major reason, followed by lack of quantity of care staff, which could lead to poor quality care being delivered. But, really good quality care should be there at all times and the majority of carers will provide good quality care, but good quality means differently to carers and those being cared for. Arriving on time and providing care to the care plan could be one definition of good quality care. But, in the care plan should be respecting choices of the person receiving care and what may have been so yesterday, may not be today, as when receiving care our ability to change is not withdrawn and our mood or preference may change from day to day and the delivery of care should reflect this be it in the care plan or not. A care plan should not be ‘written in stone’ and while reviewed at regular intervals say, 6 months, should also reflect choices on a day to day basis, which would be recorded in the daily record sheets.
Much more needs to be done and seen to be done around person-centred care for this is how care should be.